Document Type

Thesis

Degree Name

Master of Science (MSc)

Department

Kinesiology

Faculty/School

Faculty of Science

First Advisor

Quincy Almeida

Advisor Role

Thesis Supervisor

Abstract

Walking is an exercise that has been thought to benefit Parkinson’s disease (PD). In a laboratory setting treadmills have been employed to successfully improve certain aspects of gait in PD (Cakit et al., 2007, Fisher et al., 2008, Herman et al., 2007, Miyai et al., 2000, Miyai et al., 2002, Pohl et al., 2003). Research has also indicated that walking with visual cues can improve aspects of gait that are impaired in PD (Azulay et al., 1999, Bagely et al., 1997, Nieuwboer et al., 2007), however, the integration of visual cues and treadmill training has yet to be studied. Thus, the purpose of this thesis was to determine the effect of treadmill training in PD, with and without the availability of concurrent visual feedback.

The first chapter was focused on identifying previous exercise strategies that have been utilized in PD. Since a multitude of exercise interventions have been investigated, an evaluation of previous literature included analysis of a number of critical factors including: frequency, intensity and duration of training, the participant sample size, and outcome measures employed. Further, a review of recent PD aerobic testing and training studies guided the development of the current treadmill testing and training protocols.

The second chapter examines the influence of 12 weeks of treadmill training with and without concurrent visual feedback on PD motor symptom severity, physiological efficiency and gait responses at baseline, immediately after training and again six weeks later. Findings showed that the motor symptom severity scores worsened immediately after training and remained unchanged six weeks later. However, improvements in aerobic efficiency were found immediately after treadmill training that remained improved at six weeks post training. Similarly, the spatio-temporal characteristics of gait improved immediately after treadmill training and were also maintained at six weeks post training. Overall, immediately after treadmill training with concurrent visual feedback greater gait and aerobic improvements were found that did not wear off when compared to training without this feedback. The results of this study suggest that treadmill training does not improve motor symptom severity. However, treadmill training as a rehabilitative strategy can offer aerobic and gait improvements in PD.

The third chapter examines the influence of 12 weeks of treadmill training in PD with and without concurrent visual feedback on the rate of perceived exertion, mean arterial pressure, timed up-and-go and Layfayette pegboard times at baseline, immediately after training and at follow up six weeks later. Across the assessments findings showed not only did the mean arterial pressure lower for both groups but also faster pegboard insertion and removal times were found. Further, trends indicated that with each successive assessment period all participants subjectively reported lower levels of required exertion for each workload and were also faster at the timed up-and-go test. Overall, regardless of group no detectable differences in the functional and clinical outcomes were found. However, after the treadmill training, decreased blood pressure along with faster fine motor control speeds indicated the range of potential benefits that can be attained from this form of training.

The last chapter summarizes the principle findings of this thesis that include the physiological efficiency responses, the spatio-temporal gait changes, the motor symptom severity evaluations and the clinical and functional outcomes assessed. This chapter reviews the significant findings and intriguing trends found across the three evaluation periods that included pre-test, post-test and at follow up six weeks after training was completed. These findings are interpreted to provide a platform for the continued investigation of the effects of treadmill training in PD. Similarly, the limitations that occurred were also reviewed to emphasize the necessary considerations for future work in this area. Finally to appropriately conclude and ensure the findings are easily understood, take-home messages were provided to simplify the complex nature of this study. Treadmill training has benefits to offer the PD population that include greater aerobic efficiency and corresponding improvements in gait, however this form of exercise was not successful in motor symptom severity improvement.

Convocation Year

2009

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